孔源性视网膜脱离巩膜扣带术后黄斑形态与视功能恢复的相关性  

Morphology and visual recovery of macula after scleral buckling for rhegmatogenous retinal detachments

作　　者：池新昌[1] 阮素芬[1] 刘哲[1] 徐慧群 吴苗琴[1] 

机构地区：[1]浙江省人民医院眼科,杭州310014 [2]淳安县第一人民医院眼科

出　　处：《浙江医学》2012年第1期6-8,共3页Zhejiang Medical Journal

摘　　要：目的探讨累及黄斑的孔源性视网膜脱离巩膜扣带术后黄斑形态学改变和视功能的恢复以及两者问的相关性。方法选取接受单纯巩膜外加压或联合环扎、玻璃体腔内注气术的18例（19眼）患者，术前行双眼图形视觉诱发电位（P—VEP）检查，术后1周、1个月、1年分别行双目间接检眼镜、P—VEP与黄斑区光学相干断层扫描（OCT）检查。结果19眼术后视网膜均复位良好，观察期内未发生复发性视网膜脱离。术后1周、1个月分别有9、6眼表现为黄斑部视网膜浅脱离，术后1年所有术眼黄斑区视网膜均解剖复位。与术前比较，术后各时点P—VEP潜时均未发生明显变化（P〉0．05），P—VEP峰值均明显增大（P〈0．05）；随着时间的延长，P—VEP峰值呈逐渐增大趋势（P〈0．05），黄斑区视网膜神经纤维层（RNFL）厚度呈逐渐下降趋势（P〈005）。随着黄斑区RNFL厚度的下降，P—VEP潜时缩短，P—VEP峰值增加，均表现出明显的相关性（P〈0．05）。结论孑L源性视网膜脱离巩膜扣带术后，视网膜下液的残留是黄斑部视网膜神经上皮层脱离的主要原因，术中视网膜下液的引流有助于减少脱离的发生。视网膜脱离复位术后黄斑形态与视功能的恢复呈正相关。Objective To investigate changes of macular morphology and visual function after scleral buckling for macula-off rhegmatogenous retinal detachments. Methods Eighteen patients （19 eyes） with uncomplicated macula-off retinal detachment underwent episcleral surgery [scleral buckling or combined with encircling and intravitreal injection of gas （C3F8）]. Subretinal fluid drainage was taken in all patients, The pattern-visual evoked potential （P-VEP） was tested before operation; and the tomographic images of the macula （OCT） and P-VEP were examined 1, 3 and 6 months after operation. Results No intra-or postoperative complications occurred in all 18 cases （19 eyes） through the observation period. Tomographic macular scans revealed the presence of subretinal fluid in 9 cases at 1 week and in 6 cases at 1 month after operation. A completely attached fovea with no subfoveal fluid was showed in all cases 1 year after surgery. The thickness of RFNL at fovea was gradually declined at 1week, 1month, and 1year after surgery （P〈O.05）; the PIO0 amplitudes was increased gradually （P〈0.01）; and the PIO0 la- tencies showed no changes （P 〉0.05）. There was significant correlation of macular RNFL thickness decreasing with P-VEP latency shortening and P-VEP peak increasing. Conclusion Slow resorption of subretinal fluid is the main cause of foveal detachment after scleral buckling for macular-off rhegmatogenous retinal detachments, and intra-operative drainage of subretinal fluid contributes to reduce the incidence of foveal detachment after surgery. The morphology of macula is correlated with visual recovery after surgery.

关 键 词：孔源性视网膜脱离 光学相干断层扫描 图形视觉诱发电位 

分 类 号：R774.12[医药卫生—眼科]